We hope the following will help you become more aware of Parkinson’s disease - it's symptoms and treatment options, as well as the support opportunities that are available in our area. Let’s try to answer a few of the most frequently asked questions about PD.
What is PD?
It is a chronic, progressive movement disorder resulting from the loss of brain cells that produce the chemical Dopamine, a neurotransmitter that controls movement and coordination.
What causes PD?
Scientists are unsure, but one popular concept involves the combination of environmental factors and genetic predisposition. Some evidence suggests that PD may sometimes be caused by illness or an accident (head trauma).
How prevalent is PD?
As many as 7 to10 million people worldwide and more than a million in the USA may have PD, with 60,000 new cases each year. A recent study estimated there are more than 7,000 cases in the six county area surrounding Salisbury. Parkinson’s disease primarily affects the elderly, with onset of symptoms occurring on average close to age 60, although 10-20% of cases may be “young onset” under age 40. PD affects approximately 1 in 100 people above age 60 and 1 in 10 above age 80. It is the second most prevalent neurodegenerative disease after Alzheimer’s.
What are the symptoms of PD?
There are many, but four are considered hallmark symptoms used for diagnosis by neurologists employing the Unified Parkinson’s Disease Rating Scale (UPDRS): (1) Tremor at rest; (2) Muscle rigidity/stiffness; (3) Slowness of movement; (4) Postural instability (balance, coordination). Additionally, there are both “motor” (shuffling walk, freezing, small handwriting, reduced manual dexterity, muscle cramps or spasms) and “non-motor” symptoms (constipation, sleep issues, reduced cognitive abilities such memory recall, multi-tasking, planning, decision making; conditions including anxiety, depression and dementia).
How do you treat PD?
There is no cure. The primary objective is to improve the quality of life by treating the symptoms, most often through the use of medicine to replace dopamine in the brain. The “gold standard” medication is the combination drug Carbidopa/Levodopa (Sinemet). Levodopa is converted into dopamine in the brain and Carbidopa mitigates certain adverse conditions to enhance the efficacy of the Levodopa. There are important timing considerations in the use of Sinemet since absorption can be reduced during the digestive process if taken too closely to the consumption of certain proteins.
Other drugs are often used at various stages of disease progression to treat symptoms or augment the effect of carbidopa/levodopa. Dopamine Agonists mimic dopamine by stimulating the receptors in the brain. Sometimes agonists are used alone in early treatment, and later to enhance the use of Carbidopa/Levodopa. MAOB Inhibitors reduce the breakdown of dopamine in the brain by the MAOB enzyme and COMT Inhibitors mitigate the breakdown of levodopa before it reaches the brain by inhibiting the COMT enzyme.
Surgery is becoming a more frequent intervention. Deep brain stimulation (DBS) involves a battery-operated medical device, surgically implanted into the body to deliver electrical stimulation to electrodes implanted in specific areas of the brain that control movement. This reduces some of the symptoms and can allow a reduction of medications. It’s like a “pacemaker” for the brain.
Additionally, exercise is considered to be therapeutic and vital to maintaining quality of life (affecting flexibility, balance, reducing falls). Done regularly and at fairly intense levels it is thought by some to slow the progression of PD (whereas medication, presently, can only help manage symptoms).
What about research?
Research typically falls into one of three categories: (1) development of medicines or techniques to reduce or manage symptoms. (2) discovery or development of neuroprotective agents or processes that will slow or halt the progression of PD or (3) discovery or development of neuroregenerative agents or processes that can reverse the disease. Techniques on the research horizon include gene therapies that target specific regions of the brain; stem cell therapy using a patient’s own cells, modified in the lab; and new drug delivery mechanisms such as the transdermal patch, intranasal and inhalation administration, and duadopa therapy (pump infusion directly to the small intestine).
What kind of support is available?
The Delmarva Parkinson’s Alliance (www.DelmarvaParkinsonsAlliance.org) is comprised of local support groups from Wilmington, DE to Onancock, VA., with the latest two additions being the group in Seaford, DE, and the Worcester Parkinson's Support Group in Berlin, MD.
Check the DPA website for the location of a group near you. Please click on the tab “Find a Group” in the menu at the top of this page and use the interactive map or the listings by state to find the group meeting times, contact information and more. Then just come to a meeting!